Klinische Monatsblatter fur Augenheilkunde最新文献

{"title":"Autologous Contralateral and Ipsilateral Rotational Penetrating Keratoplasty - A Case Series and Mini-Review.","authors":"Adrien Quintin, Alexandra Serfözö, Loay Daas, Shady Suffo, Berthold Seitz","doi":"10.1055/a-2211-9086","DOIUrl":"10.1055/a-2211-9086","url":null,"abstract":"<p><p>Corneal stromal opacities can severely impact visual acuity if they are located in the visual axis. Homologous penetrating keratoplasty (HPK) is usually the preferred surgical option in such clinical circumstances. However, autologous penetrating keratoplasty (APK) could be an immunologically safer alternative. The purpose of this study was to report the surgical technique, indications, and (dis)advantages of ipsilateral rotational and contralateral APK, as well as pre- and postoperative clinical findings of four patients who underwent contralateral APK. In ipsilateral rotational APK, eccentric trephination places the central corneal opacity at the excision edge, whereafter the corneal button is rotated to clear the visual axis. Contralateral APK is suitable for more specific clinical situations with corneal opacity in a functionally much better eye. Clear cornea of the (almost) blind eye suffering from a noncorneal pathology is transplanted to the potentially better seeing eye suffering from a corneal pathology, followed by HPK in the (almost) blind donor eye. After 18 months, potentially better-seeing eyes improved from logMAR 1.3 to 0.6 in visual acuity, with most HPK-treated weaker eyes matching preoperative levels. Considering ipsilateral rotational and contralateral APK before moving on straight towards HPK is crucial in select cases. Autologous contralateral keratoplasty should be preferred for patients with (1) corneal scars in a potentially better seeing eye and (2) a clear cornea in an (almost) blind eye, especially in cases of high risk for graft rejection.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":"52-61"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Retinal Vein Occlusions].","authors":"Nicolas Feltgen, Kristina Pfau, Josep Callizo","doi":"10.1055/a-2442-5175","DOIUrl":"10.1055/a-2442-5175","url":null,"abstract":"<p><p>As retinal vein occlusion is such a complex systemic disease, its underlying risk profile should be narrowed down individually. Ophthalmologists should always rule out glaucoma or ocular hypertension while also screening the patient for systemic vascular diseases or risk factors in particular. Intravitreally applied medication (VEGF inhibitors or steroids) and laser coagulation (focal or panretinal) or a combination thereof can be considered to treat such retinal anomalies.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":"71-86"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correction: Differential diagnosis of age-related macular degeneration].","authors":"Peter Charbel Issa, Samantha R De Silva, Kristina Pfau, Johannes Birtel","doi":"10.1055/a-2524-5086","DOIUrl":"https://doi.org/10.1055/a-2524-5086","url":null,"abstract":"","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":"242 1","pages":"e1"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological Findings of Epithelial Invasion after Arcuate and Radial Keratotomies.","authors":"Alexandra Serfözö, Fidelis Flockerzi, Tim Berger, Adrien Quintin, Berthold Seitz","doi":"10.1055/a-2457-6977","DOIUrl":"10.1055/a-2457-6977","url":null,"abstract":"<p><strong>Background: </strong>Complications after arcuate (АKs) and radial keratotomies (RKs) may include infection, delayed wound healing, and epithelial invasion.</p><p><strong>Purpose: </strong>To assess the histopathologic findings of epithelial invasion following АK/RK.</p><p><strong>Methods: </strong>The study included patients who underwent penetrating keratoplasty (PK) after previous АK or RK treatment. In corneas with histologically confirmed epithelial invasion, the following parameters were examined: invasion depth (µm), width (µm) in the superficial, middle, and deep stroma, and the ratio of invasion depth to corneal thickness. The time between АK/RK and PK was compared for corneas with and without detectable epithelial invasion.</p><p><strong>Results: </strong>Out of 31 excised corneas, 7 (22%) showed epithelial invasion 2 to 19 years (median 6 years) after АK/RK. Histological examination revealed different invasion patterns, with a mean depth of 315 (231 to 395) µm or 57% (46 to 66%) of corneal thickness. The mean width in the superficial stroma was 291 (75 to 789) µm, in the middle stroma 210 (33 to 422) µm, and in the deep stroma 164 (19 to 324) µm. No significant association was found between the presence of the epithelial invasion and the time after PK (p = 0.83).</p><p><strong>Conclusion: </strong>In almost a quarter of the eyes after АK or RK, epithelial invasion could be detected. The potential biomechanical instability associated with this should be considered in cases of trauma as well as in the context of planning cataract surgery or PK, particularly in the hands of less experienced surgeons. Nonmechanical contact-free excimer laser trephination may be helpful in PK.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Reproducibility of Measurements of Peripapillary Blood Flow with Laser Speckle Flowgraphy in Healthy and POAG Subjects.","authors":"Alexander von Vopelius-Feldt, Timothy Hamann, Andreas Mayr, Marc Töteberg-Harms","doi":"10.1055/a-2469-8403","DOIUrl":"https://doi.org/10.1055/a-2469-8403","url":null,"abstract":"<p><strong>Background: </strong>Peripapillary blood flow is of diagnostic value in glaucoma.</p><p><strong>Material and methods: </strong>We investigated the reproducibility of peripapillary blood flow measurements in healthy individuals and in open-angle glaucoma (OAG) patients with the Nidek laser speckle flowgraphy (LSFG)-NAVI system. Blood flow was calculated as the mean of vascular area (MV), mean of tissue area (MT), and mean of overall flow (MA). Intra-rater, inter-session, and inter-rater reproducibility were assessed by determining the intraclass correlation coefficient (ICC) and coefficient of variance (COV).</p><p><strong>Results: </strong>There were 28 healthy subjects and 16 patients with OAG who participated in this prospective single-center trial. ICC and COV of intra-rater reproducibility were assessed in MV as 0.901; 6.424, MT as 0.909; 4.025, and MA as 0.965; 4.168. Inter-session reproducibility yielded ICC and COV values of MV (0.834; 9.223), MT (0.904; 6.215), MA (0.909; 7.069). Inter-rater reproducibility was computed for MV as 0.78; 9.758, MT as 0.890; 7.210, and MA as 0.888; 6.942. There was a significant difference in MA (p = 0.0184) between the healthy individuals (mean 36.299) and the OAG group (mean 24.944), which was not observed for MV (p = 0.0735) or MT (<i>p = </i>0.1351).</p><p><strong>Conclusion: </strong>High reproducibility of measurements of peripapillary blood flow with the LSFG system was demonstrated in both groups. There is a difference in peripapillary blood flow between healthy controls and OAG patients.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Measurement of Strabismus Angle Using a Commercial Virtual Reality Headset.","authors":"Rino Vicini, Dominik Brügger, Hilary Grabe, Mathias Abegg","doi":"10.1055/a-2466-0284","DOIUrl":"https://doi.org/10.1055/a-2466-0284","url":null,"abstract":"<p><p>Current clinical measurements of strabismus angles (SAs) are manual and require a skilled examiner and active cooperation by patients. This results in high interexaminer variability, and clinical use is limited by the availability of trained examiners. An objective and automated procedure, independent of the examiner, would be useful. This single-center, prospective, diagnostic feasibility study compared the vertical and horizontal SA of patients, as measured with a commercially available virtual reality headset (VRH) and custom software with the gold standard measurements performed manually with the Harms tangent screen (HW) and the alternate prism cover test (ACT). We implemented the ACT by showing the patient a fixation target on each eye alternatively with the VRH while recording the eye position of the patient. We then processed the data with custom written software to calculate the SA of the patients. These measurements were then compared to the SA measured with HW and the clinical ACT. Thirty-three patients took part in our study. We found good correlation between the VRH method and the HW as well as the clinical ACT. Best correlation was found for horizontal SA in the primary position, with the vertical SA in the primary position also correlating well. Peripheral gaze resulted in a slightly lower correlation due to the overestimation of horizontal SA and underestimation of vertical SA; cyclorotation was not measured with the VRH. Overall, VRH, HW, and clinical ACT correlated similarly well as the published interexaminer correlation for ACT. The automated measurement of strabismus with a VRH is feasible, easily applicable, fast, accurate, and can be run on consumer hardware that is affordable and increasingly available.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Ocular Biometry Measurements from Two Swept-Source OCT Devices: Eyestar 900 vs. Anterion.","authors":"Julian V Kool van Langenberghe, Petra Schwarzer, Tobias Jahn, Christoph Tappeiner, Dimitrios Kyroudis, Eva Vrbka, David Goldblum","doi":"10.1055/a-2463-4061","DOIUrl":"https://doi.org/10.1055/a-2463-4061","url":null,"abstract":"<p><strong>Background: </strong>Advanced swept-source optical coherence tomography (SS-OCT) devices are the current gold standard for the measurement of ocular biometric and keratometric parameters, which are essential for the calculation and selection of intraocular lenses (IOLs). This study compares the agreement of two SS-OCT devices, the Eyestar 900 (Haag-Streit, Köniz, Switzerland) and the Anterion (Heidelberg Engineering, Heidelberg, Germany).</p><p><strong>Materials and methods: </strong>All patients undergoing cataract surgery or seeking consultation for corneal abnormalities between January 2024 and May 2024 were eligible for inclusion. Both eyes were included in the final analysis.</p><p><strong>Results: </strong>A sample of 86 eyes from 43 patients was analysed. The mean differences (ES-AN) across all data between the Eyestar 900 (ES) and Anterion (AN) were as follows: anterior chamber depth (ACD) - 0.080 mm (ICC > 0.926), axial length (AL) 0.015 mm (ICC > 0.99), central corneal thickness (CCT) 0.914 µm (ICC > 0.921), corneal curvature along the flat meridian (K1) - 0.024 D (ICC > 0.904), and steep meridian (K2) - 0.210 D (ICC > 0.902), white-to-white corneal diameter (WTW) 0.215 mm (ICC > 0.81). There was excellent agreement for ACD, AL, CCT, K1, K2, and WTW. However, the corneal axis (AX) showed only moderate agreement (ICC > 0.389), with a mean difference of 5.97° and a notable standard deviation of 58.6°.</p><p><strong>Conclusions: </strong>The Eyestar 900 and Anterion demonstrated substantial agreement for all parameters except for the corneal meridian axis. It may be assumed that the inclusion of eyes with irregular corneal topographies may have contributed to this discrepancy.</p><p><strong>Summary: </strong>Overall, there was a high level of agreement between the Eyestar 900 and Anterion. It is reasonable to assume that the measurement outcomes provided by both devices are interchangeable for the calculation of target refractive outcomes for intraocular lenses, with no clinically relevant differences.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Ophthalmology Residency Training in Switzerland: A Trainee-Based Survey.","authors":"Amr Saad, Rino Vicini, Nastasia Foa, Frédéric Villard, Sarah Vez, Anne Catherine Karal-Biechl, Virginie Bühler, Lilly Khamsy, Ferhat Turgut","doi":"10.1055/a-2460-0047","DOIUrl":"https://doi.org/10.1055/a-2460-0047","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the current status of ophthalmology residency training in Switzerland and provide insights for enhancing training programs.</p><p><strong>Materials and methods: </strong>The survey covered demographic data such as gender, age, workplace, and year of residency, as well as working conditions, current practical and diagnostic skills, interest in scientific work, and future plans. It consisted of 16 multiple choice questions (MCQ), 5 multiple select questions (MSQ), 8 free-text, 6 Net Promoter Score (NPS), and 4 Likert scale questions. All Young Swiss Ophthalmologists (YSO) members received an invitation to participate in the survey using an online form. All collected data were anonymized, and participants provided their consent for data collection, analysis, and publication.</p><p><strong>Results: </strong>The survey assessed the perspectives of 63 Swiss ophthalmology residents on their training experiences. Respondents indicated the greatest interest in specializing in cataract and vitreoretinal surgery, followed by cornea, glaucoma, refractive surgery, and lid surgery. They also expressed a great need for improved supervision, structured curricula, and alignment of clinical and research duties. While pursuing additional surgical training and private practice autonomy, residents also expressed a preference for balanced workloads that emphasize patient care over full-time academic work.</p><p><strong>Conclusion: </strong>The survey indicates a need to standardize ophthalmology residency training in Switzerland to ensure comprehensive and uniform education. It also highlights specific areas for improvement, such as the absence of surgical training. Ongoing assessments are necessary to evaluate future developments.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supervised Automated Kinetic Perimetry (SAKP) Using Simulated Visual Field Data - Presentation of a New Examination Technique.","authors":"Ulrich Schiefer, Michael Wörner, Ditta Zobor","doi":"10.1055/a-2427-3556","DOIUrl":"https://doi.org/10.1055/a-2427-3556","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to develop, optimise, train, and evaluate an algorithm for performing Supervised Automated Kinetic Perimetry (SAKP) using digitalised perimetric simulation data.</p><p><strong>Methods: </strong>The original SAKP algorithm was based on findings from a multicentre study to establish reference values by semi-automated kinetic perimetry (SKP) combined with an automated examination method with moving stimuli (\"Program K\", developed in Japan). The algorithm evaluated the outer angles of isopter segments and responded to deviations from expected values by placing examination vectors to measure the outer boundaries of the visual field (VF). Specialised interpolation methods were also used to create individual 3D hills of vision and local \"probing vectors\" to optimise the eccentricity of the vector origins. This algorithm was trained iteratively on seven representative digitalised 3D VF results from five typical classes and optimised in each step: (1) Normal VF, (2) Central scotoma, (3) Concentric VF constriction, (4) Retinal nerve fibre layer defects in the visual field (VFDs), (5) VFDs with respect to the vertical meridian. The optimised SAKP algorithm was then applied to a new set of twenty 3D VF results of varying origin and severity. The primary targets were measured in agreement between actual calculated VF expressed as accuracy (A), that is, the ratio between the area containing correct predictions and total area of predictions measured between 0 = worst and 1 = best, and examination duration (T). The results are given as median (and interquartile range). We also verified the test's robustness by varying individual error rates (ERs) and error magnitudes (EMs).</p><p><strong>Results: </strong>The median and interquartile range (IQR, in brackets) for the total of representative VFs were 0.93 (0.02) for A and 7.0 min (5.2 min) for T, respectively. A gave the best result for altitudinal VFDs and VFDs with hemianopic character and macular sparing (0.98 each) and worst in superior wedge-shaped VFDs (0.78); T was shortest in blind spot displacement (3.9 min) and longest in hemianopic VFDs with hemianopic character and macular sparing with preserved temporal crescent (12.1 min). Error rate and magnitude (up to 30% each) only showed a comparatively low influence on A and T.</p><p><strong>Conclusion: </strong>The SAKP algorithm presented here achieves a comparatively high degree of accuracy and robustness for actual, simulated visual field data within acceptable examination times. This algorithm is currently being prepared for application in real patient examinations under clinical conditions.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a Novel Virtual Reality-Based Pupillography Device for Glaucoma Management: Cross-Sectional Cohort Pilot Study.","authors":"Karim El-Koussy, René Höhn, Mariana B L Falcão, Bruno Hauser, Avantika Naidu, Mathias Abegg","doi":"10.1055/a-2460-0147","DOIUrl":"https://doi.org/10.1055/a-2460-0147","url":null,"abstract":"<p><strong>Background: </strong>Current standard methods in monitoring glaucoma progression, like optical coherence tomography (OCT) and standard automated perimetry (SAP), have limitations in certain cases. Automated relative afferent pupillary defect (RAPD) and pupillary light reflex (PLR) testing may offer more objective alternatives. This pilot study aimed to evaluate whether RAPD could sufficiently distinguish between the two eyes in asymmetrical glaucoma, and thus could lay the foundation for using the PLR of a single eye to monitor progression longitudinally.</p><p><strong>Methods: </strong>Twenty-one patients underwent quantitative PLR measurements using a virtual reality headset. RAPD was calculated by subtracting the amplitude of PLRs between eyes. Both RAPD and relative SAP (measured using the mean defect or MD) results were correlated to the thickness of the peripapillary retinal nerve fiber layer (RNFL), as measured by OCT.</p><p><strong>Results: </strong>Data from 18 patients was analyzed after exclusions. RAPD significantly correlated with differences between the two eyes as measured by RNFL thickness (Pearson r = 0.79, p = 0.05). MD differences correlated slightly better with RNFL differences (Pearson r = 0.87, p < 0.05). RAPD and MD combined yielded an improved prediction of RNFL differences by 5% compared to using MD only.</p><p><strong>Conclusions: </strong>RAPD measurements reliably detected asymmetries in optic nerve damage in glaucoma patients. SAP measurements correlated better with OCT results than RAPD results. However, SAP and RAPD combined led to an improved prediction of RNFL thickness. This could possibly allow us to use PLR only over longer periods of time to monitor glaucomatous optic nerve damage in a single eye in the future.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}